United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 05-3110

___________

Rick Plemmons, *

*

Plaintiff-Appellee, *

* Appeal from the United States

v. * District Court for the

* Western District of Missouri.

J. T. Roberts, Pulaski County Sheriff; *

The County of Pulaski, Missouri; *

Ronald Jones; Michael Gibbens, *

*

Defendants-Appellants. *

___________

Submitted: February 17, 2006

Filed: March 3, 2006

___________

Before LOKEN, Chief Judge, LAY and SMITH, Circuit Judges.

___________

LAY, Circuit Judge.

Rick Plemmons brought action under 42 U.S.C. § 1983 alleging Sheriff J.T.

Roberts, jailer Michael Gibbens, jailer Ronald Jones, and Pulaski County, Missouri

(“Defendants”) violated his constitutional rights by showing deliberate indifference

to his medical needs while he was an inmate in the Pulaski County Jail. Specifically,

Plemmons argues jailers Gibbens and Jones inexcusably delayed in summoning an

ambulance even though Plemmons had told them he had a history of heart trouble,

then began exhibiting obvious heart attack symptoms. Plemmons also argues Pulaski
1

The Honorable Scott O. Wright, United States Judge for the Western District

of Missouri.

2

On appeal, Plemmons moved to supplement the record with the deposition of

jail inmate Herbert Alan Dodd. Because we conclude the district court properly

denied summary judgment on the basis of the record without Dodd’s testimony, we

find it unnecessary to rule on Plemmons’ motion.

3

The inmates at the jail were not allowed to keep watches, and no clock is

visible from their cells. Thus, they could only estimate when Plemmons’ attack

occurred and the time that passed between events.

-2-

County failed to properly train Gibbens and Jones to deal with such an emergency.

Finally, Plemmons alleges the jailers’ delay in calling an ambulance was influenced

by Sheriff Roberts’ policy requiring his personal authorization for ambulance

transfers. The Defendants brought a motion for summary judgment on the grounds

of qualified immunity, which the district court1

 summarily denied. Defendants now

appeal. We affirm.2

I.

Rick Plemmons was arrested on August 10, 2002 for allegedly failing to pay

child support. Plemmons was forty-six years old at the time. On August 12, 2002,

Plemmons was transferred to the Pulaski County Jail, where he was booked between

10:00 and 11:00 a.m. Plemmons alleges he advised jailer Michael Gibbens he had

a history of heart problems and had experienced two heart attacks. However, the

intake form filled out by Gibbens does not mention Plemmons’ history of heart

problems. According to Plemmons, on the afternoon of August 12, he began

suffering chest and arm pain and was sweating profusely. He stated he does not know

the precise time his symptoms began, but he believes they started shortly before 4:00

p.m.3

 He claims his cell-mate, John Thompson, notified jail staff that Plemmons was

ill a number of times via a “call box” in their cell, and that “Mike,” one of the jailers,
-3-

came to check on Plemmons around 4:00 p.m. Plemmons claims he told “Mike” he

was having heart trouble, but states the jailer left without doing anything. Plemmons’

condition worsened, and he experienced increased chest pain and nausea. Plemmons

alleges that “Mike” and an unidentified jailer came back twenty-five minutes after

“Mike’s” first visit, and Plemmons told them he thought he was having a heart attack.

Plemmons claims the two jailers then took him to the booking area and had him sit

on a bench while they finished processing a prisoner. One of the jailers then called

to have an ambulance dispatched, which Plemmons claims was roughly ten to fifteen

minutes after he was removed from his cell, and more than fifty minutes from the time

the jailers were first notified of his condition.

In his deposition, Thompson, Plemmons’ cell-mate, offered a slightly different

version of events. According to Thompson, Plemmons became ill around 4:00 p.m.

Thompson stated he believed Plemmons was having a heart attack and tried to alert

jailer Ron Jones by pushing the call box button in the cell, but received no response.

Thompson stated that about fifteen to twenty minutes later, Jones walked by the cell

and Thompson told Jones that Plemmons was ill, but Jones dismissed Plemmons’

symptoms as an anxiety attack before walking away. When Jones walked by a short

time later, Thompson told him Plemmons was having a heart attack, and Jones called

to have an ambulance dispatched.

The Defendants point out many of the assertions made by Plemmons are

contradicted by the jailers on duty that day. Gibbens stated in his deposition he left

work at 4:00 p.m. on August 12 and had no personal recollection of Plemmons’ heart

attack. Jones stated he promptly went to Plemmons’ cell after the jail trustee, Charles

Eoff, notified him Plemmons was having trouble breathing. He stated he then took

Plemmons to the front of the jail, where he immediately called to have an ambulance

dispatched. Jones denied he was notified of Plemmons’ condition via the call box in

Plemmons’ cell and stated he did not know Plemmons was having a heart attack, as

he recalled Plemmons complaining only of having difficulty breathing. Jail trustee
4

Eoff’s testimony significantly contradicts Jones’ testimony on a number of

fronts, however. For example, while Jones claimed Plemmons walked with little

assistance to the front of the jail to wait for the ambulance, Eoff stated Plemmons

collapsed in the hall outside his jail cell, where he was treated by paramedics before

being transported to the hospital. Eoff also stated Plemmons complained of chest

pain, contradicting Jones’ testimony that Plemmons complained only of difficulty

breathing. Eoff also claims he directly told Jones that Plemmons believed he was

having a heart attack.

-4-

Eoff corroborated Jones’ statement that he (Eoff) notified Jones of Plemmons’ illness

and that Jones promptly checked on Plemmons, then summoned an ambulance.4

Dispatch records indicate an ambulance was called at 4:51 p.m. and arrived at

the jail at 4:56. One of the paramedics stated Plemmons was “in trouble” when the

ambulance arrived, and that Plemmons stated he had been “like this” for forty-five

minutes. Plemmons suffered from a severe heart attack, and Dr. William Woods

observed in his deposition that damage to Plemmons’ heart could have been

minimized had he received medical care sooner.

Plemmons also has submitted evidence indicating the jailers’ delay in calling

an ambulance was influenced by Sheriff J.T. Roberts’ policy requiring jailers to notify

him before an ambulance is summoned to transport an inmate to the hospital. The

record indicates Gary Carmack, Pulaski County Ambulance District Administrator,

had previously criticized Roberts for delaying inmate treatment and that Carmack had

ordered his paramedics to document the occasions when, as a result of Roberts’

policy, patients at the jail were not permitted to be transported from the jail by

ambulance against the medical advice of physicians.

Plemmons also has submitted evidence indicating Pulaski County failed to

adequately train Jones and Gibbens to respond to Plemmons’ heart attack, pointing

out Jones stated in his deposition he had never seen the Jail Policy and Procedures
-5-

Manual and that it was not in use at the time of Plemmons’ heart attack. Neither

Jones nor Gibbens had received training from Pulaski County to assist them in

identifying heart attack symptoms, and, according to Plemmons, neither recognized

symptoms obvious to a lay person.

II.

The doctrine of qualified immunity protects governmental officials from civil

liability when “‘their conduct does not violate clearly established statutory or

constitutional rights of which a reasonable person would have known.’” Sexton v.

Martin, 210 F.3d 905, 909 (8th Cir. 2000) (quoting Harlow v. Fitzgerald, 457 U.S.

800, 818 (1982)). In ruling on a qualified immunity issue, courts must apply a twopart inquiry. First, a court must determine whether “[t]aken in the light most

favorable to the party asserting the injury, . . . the facts alleged show the officer’s

conduct violated a constitutional right.” Saucier v. Katz, 533 U.S. 194, 201 (2001).

If a “violation [can] be made out on a favorable view of the parties’ submissions,” the

reviewing court must then ask whether “the right was clearly established . . . . in light

of the specific context of the case.” Id. “For a right to be considered clearly

established, the ‘contours of the right must be sufficiently clear that a reasonable

official would understand that what he is doing violates that right.’” Lawyer v. City

of Council Bluffs, 361 F.3d 1099, 1103 (8th Cir. 2004) (quoting Anderson v.

Creighton, 483 U.S. 635, 640 (1987)).

We review a district court’s denial of summary judgment de novo. Hudson v.

Norris, 227 F.3d 1047, 1050 (8th Cir. 2000). Ordinarily, a denial of summary

judgment is not a final decision and thus is not immediately appealable. Id.; see 28

U.S.C. § 1291. However, a denial of summary judgment on qualified immunity may

be reviewed on interlocutory appeal “when the issue presented ‘is a purely legal one:

whether the facts alleged . . . support a claim of violation of clearly established law.’”

Hudson, 227 F.3d at 1050 (quoting Mitchell v. Forsyth, 472 U.S. 511, 528 n.9
-6-

(1985)). Because qualified immunity is “an immunity from suit rather than a mere

defense to liability,” Hunter v. Bryant, 502 U.S. 224, 227 (1991), its availability

“ordinarily should be decided by the court long before trial.” Id. at 228. However,

“the nonmoving party is still given the benefit of all relevant inferences at the

summary judgment stage, and if a ‘genuine dispute exists concerning predicate facts

material to the qualified immunity issue, the defendant is not entitled to summary

judgment on that ground.’” Hudson, 227 F.3d at 1050 (quoting Pace v. City of Des

Moines, 201 F.3d 1050, 1056 (8th Cir. 2000)); see also Fed. R. Civ. P. 56 (c). 

Here, the district court denied the Defendants’ motion for summary judgment

on the ground of qualified immunity, stating, “there are material facts in dispute that

must be resolved by a jury.” To affirm this conclusion, we must first find the

evidence in the record, when viewed in the light most favorable to Plemmons, would

allow a reasonable fact finder to conclude the Defendants engaged in a course of

conduct that violated his clearly established constitutional rights. We must then find

as a matter of law that no reasonable official could have thought that such a course

of conduct was lawful.

III.

A.

We first ask whether the evidence in the record, viewed in the light most

favorable to Plemmons, would lead a reasonable fact finder to conclude the

Defendants engaged in a course of conduct that violated Plemmons’ clearly

established constitutional rights. “The Eighth Amendment prohibits prison officials’

cruel and unusual punishment of inmates . . . .” Tlamka v. Serrell, 244 F.3d 628, 632

(8th Cir. 2001). This prohibition against cruel and unusual punishment has been

interpreted as obligating prison officials to provide inmates in their custody with

medical care. Id. A prison official violates an inmate’s right to medical care if his
-7-

or her conduct amounts to a “deliberate indifference to [the prisoner’s] serious

medical needs.” Id. (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)). To

establish a claim of deliberate indifference, an inmate must show “‘(1) that [he]

suffered objectively serious medical needs and (2) that the prison officials actually

knew of but deliberately disregarded those needs.’” Id. (quoting Dulany v. Carnahan,

132 F.3d 1234, 1239 (8th Cir. 1997)).

In Ruark v. Drury, 21 F.3d 213, 216 (8th Cir. 1994), we observed “[i]t is well

settled that an intentional delay in obtaining medical care for a prisoner who needs

it may” violate the Eighth Amendment. For delay to create an actionable Eighth

Amendment violation, however, 

the information available to the prison official must be such that a

reasonable person would know that the inmate requires medical

attention, or the prison official’s actions (or inaction) must be so

dangerous to the health or safety of the inmate that the official can be

presumed to have knowledge of a risk to the inmate.

Tlamka, 244 F.3d at 633; see also Ruark, 21 F.3d at 216.

Although the facts in Tlamka differ from the facts here, they are sufficiently

similar to provide guidance in determining whether the alleged conduct of the

Defendants in this case amounted to deliberate indifference to Plemmons’ serious

medical needs. In Tlamka, Frank J. Tlamka suffered a heart attack while in the

custody of prison officials and later died. 244 F.3d at 630. His family brought a

§ 1983 claim, alleging prison officials ordered inmates who were performing

cardiopulmonary resuscitation (“CPR”) on Tlamka to desist, despite the fact that

Tlamka appeared to be responding favorably. Id. at 630-31. The officials’ alleged

order resulted in Tlamka going without necessary medical care for up to ten minutes,

while his condition noticeably deteriorated. Id. at 631. We first observed that the

parties agreed Tlamka’s medical condition was objectively serious, as it was obvious
-8-

to those present his condition was life threatening. Id. at 633. Thus, we focused our

analysis on whether the prison officials actually knew of Tlamka’s needs, but

deliberately disregarded them. Although“somewhat wary” of the allegation that

prison officials stood idle for ten minutes while Tlamka’s condition worsened, we

emphasized that “[a]t this stage of the litigation . . . we must accept the facts as recited

in the affidavits filed by the prisoners as true.” Id. at 634. Accordingly, we held the

prison officials’ alleged failure to act, given the obvious nature of Tlamka’s condition

and the fact that corrections officers could have provided CPR, was conduct

“sufficiently severe to evidence an Eighth Amendment violation.” Id. at 633.

In this case, the Defendants assert Plemmons did not suffer objectively serious

medical needs. However, Plemmons alleges he told the booking officer he was a

heart patient, and, roughly six hours later began experiencing classic heart attack

symptoms, including arm and chest pain, profuse sweating, and nausea—symptoms

corroborated by his cell-mate, John Thompson. Viewing the facts in the light most

favorable to Plemmons, we conclude he has established that a genuine fact dispute

exists regarding whether he suffered objectively serious medical needs.

We next turn to the question of whether the Defendants actually knew of but

deliberately disregarded Plemmons’ objectively serious medical needs. Plemmons

and Thompson allege the jailers were summoned via the call box when Plemmons

grew ill, but the call was ignored. Thompson alleges that, when the jailer finally

appeared, he dismissed Plemmons’ symptoms as an “anxiety attack” and left.

Plemmons alleges that twenty-five minutes later, two jailers returned, at which time

Plemmons requested an ambulance because he believed he was having a heart attack.

According to Plemmons, he was then taken to the booking area and was left to wait

another ten to fifteen minutes before an ambulance was summoned. Plemmons

argues this delay was caused, in part, by a policy implemented by Sheriff J.T. Roberts

requiring that all ambulance transfers be approved directly by him. Plemmons also

asserts the jailers’ failure to provide appropriate medical care was caused, in part, by
-9-

Pulaski County’s failure to train Gibbens and Jones to recognize heart attack

symptoms that would be obvious to a lay person.

There is considerable disparity in the testimony of Plemmons, Thompson, and

the jailers regarding a number of issues, including whether Gibbens was on duty

during Plemmons’ heart attack and, more importantly, how much time elapsed

between when Plemmons initially notified the jailers of his condition and when an

ambulance was called. Viewing the record in the light most favorable to Plemmons,

we conclude genuine issues of material fact are in dispute regarding whether

Plemmons notified Gibbens that he had a history of heart problems, whether Gibbens

was on duty when the jailers were apprised of Plemmons’ condition, whether they

failed to recognize heart attack symptoms that would be obvious to a lay person,

whether they acted promptly to provide necessary medical help, whether they were

properly trained to deal with such an emergency, and whether their conduct was

influenced by Sheriff Roberts’ policy requiring authorization for ambulance transfers.

In sum, viewing the facts in the light most favorable to Plemmons, he has established

genuine issues of material facts are in dispute regarding whether the Defendants

actually knew of, but deliberately disregarded, his medical needs. See Tlamka 244

F.3d at 634. 

The Defendants rely heavily on our statement in Ruark that “it cannot be said,

as a matter of law, that a twenty-minute delay in calling an ambulance, without more,

is sufficient to establish” a prison official acted in callous disregard of the prisoner’s

constitutional right to medical attention. 21 F.3d at 217 (citation and quotation

omitted). In Ruark, the depositions of the corrections officials indicated that once it

was determined an ambulance was necessary, the officials acted immediately, “before

anybody said why, where, and all about it.” Id. at 215. Apparently, however, it

nonetheless took twenty minutes for the dispatcher to be called. We concluded that

“without more,” the twenty-minute delay between realizing an ambulance was

necessary and calling one was not sufficient to establish an Eighth Amendment
-10-

violation. The case at hand, however, involves direct allegations the jailers were told

of Plemmons’ history of heart problems, did not respond to notice via the call box

that Plemmons was severely ill, then dismissed Plemmons’ obviously severe

symptoms as an “anxiety attack.” The facts as we must take them indicate the jailers

then delayed in returning to check on him for somewhere between fifteen and twentyfive minutes. Plemmons also alleges the jailers left him to wait in the booking area

for another ten to fifteen minutes before finally summoning an ambulance. Thus,

Plemmons alleges deliberate delay that ignored the obvious severity of his condition,

facts that did not exist in Ruark. In Ruark, it was not obvious to the jailers that the

inmate in question was ill, as he had been difficult to wake on a number of previous

occasions. However, once jail personnel realized the inmate needed medical care,

they directly sought to summon an ambulance. Thus, the delay in Ruark is

distinguishable from the delay alleged here.

B.

Having concluded that, viewing the evidence in the light most favorable to

Plemmons, he has presented sufficient facts to establish an underlying violation of his

Eighth Amendment rights, we must address whether the violation was one of clearly

established law. Saucier, 533 U.S. at 201. As noted above, to be clearly established,

the “contours of the right must be sufficiently clear that a reasonable official would

understand that what he is doing violates that right.” Anderson, 483 U.S. at 640. 

In Tlamka v. Serrell, supra, we held as a matter of law that corrections officers’

alleged delay in providing medical care to a heart attack victim whose condition was

obviously life threatening constituted conduct that violated clearly established law,

stating 

[w]hile the determination of whether that delay is constitutionally

actionable depends on the seriousness of an inmate’s medical condition
-11-

and on the reason for the delay, we conclude that under the facts we are

presented with in this summary judgment appeal, any reasonable officer

would have known that delaying Tlamka’s emergency medical treatment

for 10 minutes, with no good or apparent explanation for the delay,

would have risen to an Eighth Amendment violation. [Tlamka’s] factual

assertions, in our view, if proven to be true, would constitute a

quintessential case of deliberate indifference to serious medical needs.

244 F.3d at 635 (citation omitted).

In the case at hand, Plemmons alleges he notified Gibbens he was a heart

patient. It was patently clear to Plemmons, Thompson, and Eoff that he was having

a heart attack. Plemmons and Thompson asked for assistance for at least fifteen to

twenty minutes, but possibly for as long as fifty-one minutes. Given the facts as we

must take them, we conclude any reasonable officer would have known that a delay

in providing prompt, appropriate medical care to Plemmons constituted an Eighth

Amendment violation.

IV.

Viewing the evidence in the record in the light most favorable to Plemmons,

we hold a reasonable fact finder could conclude the Defendants violated his clearly

established constitutional rights by disregarding his need for medical care,

particularly considering Plemmons’ allegation that he stated he was a heart patient

and in light of the obviousness of his symptoms. We further hold, given the facts as

we must take them, that no reasonable official could have thought the failure to

summon immediate medical help for Plemmons was lawful. Accordingly, we affirm

the district court’s denial of summary judgment.

______________________________